Current opinion in cardiology
May 8, 2026 · via Europe PMC
Managing and predicting electrical and mechanical failure in the systemic right ventricle.
Rojas SF, Khairy P.
AI summary — for doctors, generated from the abstract only
This review discusses the interconnected relationship between heart failure and arrhythmias in adults whose main pumping chamber is a morphologic right ventricle (systemic right ventricle), explaining how each condition worsens the other and reviewing emerging treatment options; it is not a primary research study with new patient data.
What was studied
A narrative review examining the mechanisms linking systemic right ventricular dysfunction and arrhythmia development in adults with congenital heart disease whose right ventricle supports the systemic circulation, discussing implications for contemporary management including catheter ablation, device therapy, cardiac resynchronization, and conduction system pacing; this is not a primary research study with original patient outcome data.
Key findings
- Chronic systemic loading of the right ventricle promotes maladaptive structural, electrical, and inflammatory remodeling that creates a substrate for atrial and ventricular arrhythmias.
- Conversely, arrhythmias worsen systemic right ventricular dysfunction through loss of atrioventricular synchrony, tachycardia-mediated impairment, dyssynchrony, and hypoxemia.
- Advances in catheter ablation, device therapy, cardiac resynchronization, and conduction system pacing have expanded therapeutic options, though evidence guiding patient selection and timing remains limited.
Clinical relevance
This review suggests that heart failure and arrhythmias in patients with a systemic right ventricle are deeply interconnected processes that should be managed together rather than separately, and that integrating imaging, electrophysiologic assessment, and individualized risk assessment may help optimize treatment timing and device selection, though the authors note evidence guiding these decisions remains limited.
Who should care
Limitations
This is a narrative review rather than a systematic review or original study; the authors explicitly note that evidence guiding patient selection and timing for various interventions remains limited.
In adults whose heart's main pumping chamber was never designed for that role, heart failure and dangerous rhythm problems feed into each other, and doctors are developing more personalized strategies combining imaging and targeted therapies to manage both together.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Purpose of review
Adults with congenital heart disease increasingly survive into later adulthood, exposing the long-term limitations of a morphologic right ventricle supporting the systemic circulation. Heart failure and arrhythmias are common, frequently coexist, and represent leading causes of morbidity and mortality in this population. This review examines the mechanisms linking systemic right ventricular dysfunction and arrhythmogenesis and their implications for contemporary management.
Recent findings
Recent literature highlights that chronic systemic loading of the right ventricle promotes maladaptive structural, electrical, and inflammatory remodeling, creating a substrate for atrial and ventricular arrhythmias. Conversely, arrhythmias exacerbate systemic right ventricular dysfunction through loss of atrioventricular synchrony, tachycardia-mediated impairment, dyssynchrony, and hypoxemia, mechanisms to which systemic right ventricular physiologies are particularly susceptible. Advances in catheter ablation, device therapy, cardiac resynchronization, and conduction system pacing have expanded therapeutic options, although evidence guiding patient selection and timing remains limited.
Summary
Failure of the systemic right ventricle and arrhythmias are tightly interwoven processes that evolve over time. Integrating mechanistic insights with longitudinal imaging, electrophysiologic phenotyping, and individualized risk assessment may improve arrhythmia management, refine device strategies, and support more personalized approaches to preserving systemic right ventricular function.
DOI
10.1097/hco.0000000000001308
PMID
42100847
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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